View source for Intensive care unit nurses' information needs and recommendations for integrated displays to improve nurses' situation awareness

This a review of a paper submitted by Sven H Koch, Charlene Weir, Maral Haar, Nancy Staggers, Jim Agutter, Matthias Gorges, Dwayne Westenskow <ref name="Koch et al (2015)">Koch, Sven H, Weir, Charlene, Haar, Maral, Staggers, Nancy, Agutter, Jim, Gorges, Matthias, Westenskow, Dwayne (2012), Intensive care unit nurses' information needs and recommendations for integrated displays to improve nurses' situation awareness. J Am Med Inform Assoc. 2012 Jul-Aug;19(4):583-90. doi: 10.1136/amiajnl-2011-000678. Epub 2012 Mar 21. http://www.ncbi.nlm.nih.gov/pubmed/22437074 (Accessed on 3 Oct 2015)</ref>

==Research questions:==
*Will information integration displays at the bedside improve nurses’ situation awareness of patients and decease errors?

*Will an ineffective work flow be the cause of errors due to a lack of an integrated information displays at the point of care?
 
==Abstract==

The purpose of this study was to develop integrated information displays recommendations for frequent intensive care unit (ICU) nursing tasks based on the theory of situation awareness. Nurses have repeatedly requested for integrated information displays or systems to ease their workload. The authors conducted systematic observations methodology to follow 19 ICU nurses for 38 hours in 3 clinical practice settings. <ref name="Koch et al (2015)">Koch, Sven H, Weir, Charlene, Haar, Maral, Staggers, Nancy, Agutter, Jim, Gorges, Matthias, Westenskow, Dwayne (2012), Intensive care unit nurses' information needs and recommendations for integrated displays to improve nurses' situation awareness. J Am Med Inform Assoc. 2012 Jul-Aug;19(4):583-90. doi: 10.1136/amiajnl-2011-000678. Epub 2012 Mar 21. http://www.ncbi.nlm.nih.gov/pubmed/22437074 (Accessed on 3 Oct 2015)</ref>

==Background==

The authors concluded from reviewing the existing literature on patient safety and causes of medical errors, that patient in the ICU are especially at risk of errors due the complexity and severity of their medical conditions. The authors also found that 61.4% of serious errors were associated with medication ordering or the execution of medication treatment, while 14.8% was with communication between the nurses’ and the assigned providers. <ref name="Koch et al (2015)">Koch, Sven H, Weir, Charlene, Haar, Maral, Staggers, Nancy, Agutter, Jim, Gorges, Matthias, Westenskow, Dwayne (2012), Intensive care unit nurses' information needs and recommendations for integrated displays to improve nurses' situation awareness. J Am Med Inform Assoc. 2012 Jul-Aug;19(4):583-90. doi: 10.1136/amiajnl-2011-000678. Epub 2012 Mar 21. http://www.ncbi.nlm.nih.gov/pubmed/22437074 (Accessed on 3 Oct 2015)</ref>

The authors also concluded that ICU nurses are in constant information overload from their work day responsibilities. ICU nurses move constantly while obtaining and delivering information, supplies, and medication. Nurses are responsible for the monitoring and detect changes in physiological functions on a minute-by-minute basis as well as document their work, give medications, and provide care coordination. All this contributes significantly to information overload. At the point of care at the bedside, nurses have a significant responsibility to monitor the operations of medical devices as well as the patient’s needs. This does not address the other patients that they are assigned to during their work shift.

==Results==

From their finding the authors found that ICU nurses are conducting 46 different tasks during an early morning shift. This averaged to 23.5 tasks per hour. The most frequent task was charting, checking/signing medication, and administering medication. The highest frequency task categories consisted of communication, medication management and patient awareness while time spent addressing organization and direct patient care needs were excluded. To address information gaps the authors’ recommended enhancing communication, improving medication management, improve the ability to monitor patient situational awareness simultaneously at multiple locations. <ref name="Koch et al (2015)">Koch, Sven H, Weir, Charlene, Haar, Maral, Staggers, Nancy, Agutter, Jim, Gorges, Matthias, Westenskow, Dwayne (2012), Intensive care unit nurses' information needs and recommendations for integrated displays to improve nurses' situation awareness. J Am Med Inform Assoc. 2012 Jul-Aug;19(4):583-90. doi: 10.1136/amiajnl-2011-000678. Epub 2012 Mar 21. http://www.ncbi.nlm.nih.gov/pubmed/22437074 (Accessed on 3 Oct 2015)</ref>

==Discussion==

Nurses experience significant challenges in navigating and integrate their information environment between the patient’s provider and other medical infrastructures. Being able to monitor the patient’s response to medication and the medical devices operations inside the ICU is very challenging when responsibilities outside the ICU are added to the shifts’ work load such as updating the electronic medical records and acquiring the medications and services that need to be administered to the patient.

==Conclusion==

The information environment does not keep pace with the constantly changing conditions of the patient and team membership. <ref name="Koch et al (2015)">Koch, Sven H, Weir, Charlene, Haar, Maral, Staggers, Nancy, Agutter, Jim, Gorges, Matthias, Westenskow, Dwayne (2012), Intensive care unit nurses' information needs and recommendations for integrated displays to improve nurses' situation awareness. J Am Med Inform Assoc. 2012 Jul-Aug;19(4):583-90. doi: 10.1136/amiajnl-2011-000678. Epub 2012 Mar 21. http://www.ncbi.nlm.nih.gov/pubmed/22437074 (Accessed on 3 Oct 2015)</ref>

==Commentary==

Nurses lack an integrated information display inside the ICU that can provide situational awareness of both the patient and the medical devices that are used to monitor and treat the patient. Outside the ICU, the patient has been replaced by organization requirements and servicing other assigned patients needs. An integrated information display is needed to address a one on one patient requirement in addition to a many on many information display at the nurse’s assigned workstation to monitor and service other assigned patients. It does not seem that a nurse can perform 23.5 tasks per hour error less without looking into the efficiency of the workflow processes.

==Additional Reads ==
--Reducing emergency department charting and ordering errors with a room number watermark on the electronic medical record display--
[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4203453/]


References
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[[Category:HI5313-2015-FALL]]
[[Category:Reviews]]
[[Category:Interface, Usability and Accessibility]]
[[Category:Medication Errors]]